TOPIC 10

NEOPLASM
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 LEARNING OUTCOMES:
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At the end of the lesson, students should be able to:

 Define neoplasm
 Highlight the basic concepts & principles of
abnormality in tissue / cell growth.
 Differentiate between normal tissue & pathologic
tissue (neoplastic tissue).
 Identify and describe the staging and grading of
cancer
 CONTENTS
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 10.1) Nomenclature & Classification

 10.2) Special Categories of Tumours
 10.3) Characteristics of Tumours
 10.4) Prognostic Markers
 10.5) Grading & Staging of Cancer
 10.6) Epidemiology & Predisposition To Neoplasia
 8.1 Nomenclature & Classification
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 “Neoplasia”; means new growth.

 But all “new growths” are NOT NEOPLASM since
examples of new growth of tissues & cells also exist
in the processes of embryogenesis, regeneration &
repair.
 Therefore, satisfactory definition of neoplasm or
tumour is “a mass of tissue formed as a result of
abnormal, excessive, uncoordinated, autonomous &
purposeless proliferation of cells”
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 Neoplasm may be BENIGN; when they are SLOW-

GROWING & localised w/out causing much
difficulty to the host.
 Neoplasm may be MALIGNANT; when they
proliferate rapidly, spread throughout the body &
may eventually cause DEATH of the host.
 The common term used for all malignant tumours is
CANCER!!!
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 All tumours (benign & malignant) have 2 basic

components:

 i. „Parenchyma‟ comprised by proliferating

tumour cells; parenchyma determines the nature &
evolution of the tumour.
 ii. „Supportive stroma‟ composed of fibrous
connective tissue & blood vessels; it provides the
framework on which the parenchymal tumour cells
grow.
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 The suffix „-oma‟ is added to denote benign tumours.

 Malignant tumours of epithelial origin are called

carcinomas

 Malignant mesenchymal origin are named sarcomas.

 However, some cancers are composed of highly

undifferentiated cells & are referred to as
undifferentiated malignant tumours. Adenoma = arise
from glandular epithelium
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 Examples are; melanoma (carcinoma of the

melanocytes), hepatoma (carcinoma of the
hepatocytes, lymphoma (for malignant tumour of the
lymphoid tissue) & seminoma (for malignant tumour
of the testis).
 A tumour is termed medullary when it is almost
entirely composed parenchymal cells.
 8.2 Special Categories of Tumours
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 There are 5 special categories of tumours:

Mixed tumours
Teratomas
Blastomas
Hemartoma
Choristoma
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 a) Mixed tumours:
 When 2 types of tumours are combined in the same
tumour e.g.
1) adenosquamous carcinoma= combination of
adenocarcinoma and squamous cell carcinoma
2) carcinosarcoma = rare combntn malignant tumor
of epithelium (carcinoma) and mesenchymal tissue
(sarcoma)
3) collision tumor = 2 different cancers in the same
organ which do not mix each other.
4) adenoacanthoma = mixture of adenocarcinoma
and benign squamous in the endometrium
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 b) Teratomas:
 These tumours are made up of a mixture of
various tissue types arising from totipotent cells
derived from 3 germ cell layers – ectoderm,
mesoderm & endoderm.

 c) Blastomas (embryomas):
 A group of malignant tumours which arise from
embryonal or partially differentiated cells which
would normally form blastema of the organs & tissue
during embryogenesis.
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 d) Hemartoma:
 Is a benign tumour which is made of mature but
disorganised cells of tissues indigenoues to the
particular organ.

 e) Choristoma:
 Is the name given to the ectopic islands or
normal tissue. Choristoma is not a true tumour.
 8.3 Characteristics of Tumours
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 There are 5 characteristics of tumours:

Rate of growth
Clinical & gross features
Microscopic features
Local invasion (Direct spread)
Metastasis (Distant spread)
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 a) Rate of growth:
 The tumour cells generally proliferate more rapidly
than the normal cells.
 In general, benign tumours grow slowly & malignant
tumours rapidly.
 The rate at which tumour enlarges depends upon 2
main factors:
 Rate of division & destruction of tumour cells.
 Degree of differentiation.
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 The regulation of tumour growth is under the

control of growth factors secreted by the tumour
cells:

 Epidermal growth factor (EGF)

 Fibroblast growth factor (FGF)
 Platelet-derived growth factor (PDGF)
 Colony stimulating factor (CSF)
 Transforming growth factors-β (TGF-β)
 Interleukins (IL)
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 b) Clinical & gross features:

 Clinically, benign tumours are generally slow
growing & depending upon the location, may remain
ASYMPTOMATIC or may produce SERIOUS
SYMPTOMS.
 On the other hand, malignant tumours grow rapidly,
may ulcerate on the surface, invade locally into
deeper tissues, may spread to distant sites
(metastasis), & also produce systemic features such
as weight loss, anorexia & anaemia.
 Clinical & Gross Features
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FEATURES BENIGN MALIGNANT

1. Boundaries Encapsulated or Poorly

well circumscribed circumscribed &
irregular
2. Surrounding Often compressed Usually invaded
tissue
3. Size Usually small Often larger

4. Secondary Occur less often Occur more often

changes
 iii. Microscopic features
Features Benign Malignant
1. Pattern Usually resembles
18 the tissue Often poor resemblance to
of origin closely tissue of origin
2. Basal polarity Retained Often lost
3. Pleomorphism Usually not present Often present
4. Nucleo-cytoplasmic ratio Normal Increased
5. Anisonucleosis Absent Generally present
6. Hyperchromatism Absent Often present
7. Mitoses May be present but are Mitotic figures increased &
always typical mitoses are generally atypical &
abnormal
8. Tumour giant cells May be present but w/out Present with nuclear atypia
nuclear atypia
9. Chromosomal Infrequent Invariably present
abnormalities
10. Function Usually well maintained May be retained or become
abnormal
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 iv. Local invasion (Direct spread)

 Localized growth, do not penetrate the basement
membrane , known as „carcinoma in situ‟, grow
within tissue origin, enlarge and infiltrate normal
structure.

 v. Metastasis (Distant spread)

 Metastasis & invasiveness are the 2 most important
features to distinguish malignant from benign
tumours.
 Continue…
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 Cancers may spread to distant sites by following pathways:

i. Lymphatic spread= involvement of lymph node by
malignant cells in 2 form:
 #lymphatic permeation – walls of lymphatic are readily
invaded by cancer – continuous growth in lymp channel
 #lymphatic emboli – malignant cell- form tumor emboli-
carried along next draining lymph node- lodge-growth

ii. Haematogenous spread= blood borne metastasis, common

site: liver, lung, kidney, brain, several exceptn: heart, spleen.
Migrate through: systemic vein, portal vein, arterial spread and
retrograde spread.
 iii. Spread along body cavities & natural passages=
uncommon, spread under: transcoelomic spread= invade
throughserosal wall o/t coelomic cavity- carried out-
implanted elsewhere in the body cavity,eg.carcinoma of
ovary, stomach,breast
 spread along epithelium lined surfaces= unusual, intact
epithe and mucus-resistant to penetration by tumor cell,
 spread via cerebrospinal fluid= release tumor cell into
csf. / implantation.
 Synovial sarcoma, malignant mesothelioma & glioma are
examples of malignant tumours metastasise.
 6.4 Prognostic Markers
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 Recent evidence has shown that in metastatic

tumours, survival of host is correlated with some
clinical & molecular features of tumours which act as
prognostic markers.
 Clinical prognostic markers; size, grade, vascular
invasion & nodal involvement by the tumour.
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 Molecular prognostic markers; molecular indicative of poor

prognosis in certain specific tumours are:

 a. Expression of an oncogene by tumour cells

 b. CD44 molecule
 c. Estrogen receptors
 d. Epidermal growth factor receptor
 e. Angiogenesis factors & degree of neovascularisation
 f. Expression of metastasis associated gene or nucleic
acid (MAGNA) in the DNA fragment in metastasising
tumour.
 6.5 Grading & Staging of Cancer
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 Grading & staging are the 2 systems to determine the

prognosis & choice of treatment after a malignant
tumour is detected.
 Grading; defined as the macroscopic & microscopic
degree of differentiation of the tumour.
 Staging; defined as extent of spread of the tumour
within the patient.
 GRADING
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 Grading is largely based on 2 important histologic features; THE

DEGREE OF ANAPLASIA & THE RATE OF GROWTH.
 Broders‟ grading is as under:
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 Grade I: Well differentiated (less than 25% anaplastic cells
 Grade II: Moderately differentiated (25-50% anaplastic cells)
 Grade III: Moderately differentiated (50-75% anaplastic cells)
 Grade IV: Poorly differentiated or anaplastic (more than 75%
 anaplastic cells)

* Anaplasia is a lack of differentiation & is a characteristic

feature of most malignant tumours.
 STAGING
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 Staging; the extent of spread of cancers can be assessed

by 3 ways – by clinical examination, by investigations &
by pathologic examination of the tissue removed.
 2 important staging systems currently followed are TNM
staging & AJC staging.
 TNM staging: T for primary tumour, N for regional nodal
involvement & M for distant metastases was developed
by the Union Internationale Contre Cancer.
 AJC staging: American Joint Committee staging divides
all cancers into stage 0 to IV & takes into account all the
3 components of the preceding system (primary tumour,
nodal involvement & distant metastases) in each stage.
 6.6 Epidemiology & Predisposition To Neoplasia
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 Table below shows worldwide incidence (in descending order) of

different forms of cancer in men, women & children.

MEN WOMEN CHILDREN

1. Lung Breast Acute leukaemias

2. Prostate Lung CNS tumours

3. Colon-rectum Colon-rectum Lymphomas

4. Leukaemia-lymphoma Leukaemia-lymphoma Neuroblastoma

5. Liver Ovary Bone sarcomas

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 The pattern & incidence of cancer depends upon the

following epidemiologic factors:

 i. A large number of predisposing epidemiologic

factors or cofactors.
 ii. Chronic non-neoplastic (pre-malignant)
conditions.
 iii. Role of hormones in cancer.
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 Predisposing factors:

 i. Familial & genetic factors e.g. cancer of breast

 ii. Racial & geographic factors
 iii. Environmental & cultural factors
 iv. Age
 v. Sex
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 Carcinogenic influence or radiation appears after

more than ten years.
 Women receiving estrogen therapy have an increased
risk of developing BREAST CANCER,
ENDOMETRIAL CARCINOMA &
HEPATOCELLULAR CARCINOMA.
 THANK YOU
ANY QUESTION?

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